Registration
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Welcome to Swymfit! Please complete the following registration form.
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Referral Information
How did you hear about us?
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Other
Parents Magazine
Performance
Referral
Returning Family
Walk-In
Website
Referral Name
Family Information
Family Last Name
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Where do you live?
Home Address
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City
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State
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DE
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Zip
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Primary Phone
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Additional Info
Emergency Contact Info (Not Contact #1 or #2)
Agree to Photo Release?
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Contact #1
Contact #1 First Name
*
Last Name
*
Type
*
Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
How Can We Contact You?
Home Phone
Work #
Cell #
*
Portal Access (your email is your login)
Email
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(Emails are kept confidential)
Confirm Email
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Portal Account Password
Confirm Portal Account Password
Contact #2
Contact #2 First Name
Last Name
Type
Caregiver
Father
Grandparent
Guardian
Mother
Parent
Self
How can we contact you?
Home Phone
Work #
Cell #
Email
(Emails are kept confidential)
Confirm Email
Student #1
Student's First Name
*
Last Name
*
Student Gender
Female
Male
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Student #2
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
Female
Male
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Student #3
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
Female
Male
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Student #4
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
Female
Male
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Student #5
(Show-Hide Details)
Student's First Name
*
Last Name
*
Student Gender
Female
Male
Birth Date
*
Additional Info
Special Needs (Leave blank if NONE)
Add Another Student
Required Policies
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I Agree to All of the Above
Enter your Full Name
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November 21, 2024
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Address Line 1
Address Line 2
City
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AZ
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CT
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DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
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PR
VI
Zip
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